European C. elegans Neurobiology Meeting 2010
Fodele, Crete, 9-11 October 2010

REGISTRATION / ACCOMMODATION FORM

(To be sent as an e-mail message, attachment to: info@ewnm2010.gr, or faxed to +30-2810-391101)

PERSONAL DETAILS
First name:		Last name:		
						
Title:	Prof.		Dr.		Mrs.		Mr.		Gender:	Male		Female		
Affiliation:		
Street address:		
	Zip code:		City:		Country:		
e-mail address:		

REGISTRATION / ACCOMMODATION	
Per person in double room
check-in 9 October – check-out 11 October	In single room
check-in 9 October – check-out 11 October	
				
		220 Euros			285 Euros	

Sharing participant(s) name(s):		
	I would appreciate it if the organizers could find a roommate for me		

Late Registration, after 31 August 2010, please consider a penalty of 30 Euros

For different accommodation arrangements please contact the meeting secretariat by e-mail, subject to availability. 
Please note: (a) If you plant to arrive before 9 October, the prices are different based on middle season rates, (b) if you plant to stay longer, the hotel will be open until the 16th of October.
Dates:	Check in:		Check out:		Total nights:		
											
Room type:	Single		Double		Triple		Shared double		Shared triple		

PAYMENT METHODS
Your registration is considered completed ONLY when registration fees are deposited

Bank Transfer [must be made without any charges for the recipient]
Bank	:	PIRAEUS BANK
Address	:	Science & Technology Park Branch, Heraklion 71110 Crete, Greece
BIC	:	PIRBGRAA
Account Number	:	GR23-0172-7550-0057-5502-4617-652
Account Holder	:	Georgia Houlaki [EWNM2010 Secretary]
Don’t forget to mention your name when depositing the fees and send the remittance statement by fax to: +30 2810 391101 [c/o G. Houlaki]

Credit Card [You are advised NOT to send credit card details electronically. In this case, do not send the form as e-mail message attachment. Please submit the form by fax to +30 2810 391101 - c/o G. Houlaki]
Card type	:	VISA		Master Card		AmEx		Other			

Card number	:					-					-					-					

Valid	:	from			/			to			/			CVV*				
		M	M		Y	Y		M	M		Y	Y						
Holder’s name:		Signature:		

* CVV: The last 3 digits of the number at the back of the credit card